Mediastinal Ga-67 uptake in patients with lymphoma following chemotherapy

Scintigraphic imaging with [67]Ga remains an important tool in evaluating the response of lymphoma to therapy. Scintigraphic characteristics of lung hilar Ga-67 uptake [HU] and their relationship with the etiology [benign vs. malignant] of the hilar lesions in lymphoma patients following chemotherapy were retrospectively investigated. A total of 161 lymphoma patients were included in the study. The presence/absence of HU and if present, symmetry/asymmetry and intensity of HU [on the basis of a 3 scale grading system] were visually and semi-quantitatively assessed on transaxial sections of thorax Ga-67 SPECT. By drawing ROIs over right and left hilum, asymmetry index [AI%] was also calculated. HU was categorized as benign or malignant depending on the radiological correlation and clinical follow-up. In the malignant group, the majority of patients [85.7%] had grade 2 or grade 3 uptake and all had asymmetric pattern. However, in the benign group, grade 1 uptake was more common [66%] and was mainly symmetric [94.6%] in appearance. AI% in the malignant group [73.7 +/- 36.6] was significantly higher than in the benign group [5.7 +/- 4.9] confirming the marked asymmetry in malignant patients. Lung HU is a common finding in patients with lymphoma following chemotherapy and frequently benign in origin, particularly if HU is symmetric and its intensity is less than that of sternum. Asymmetry index [AI%] as proposed in the present study can be used when visual assessment for the symmetry of HU is inconclusive

Combined chemoreduction and adjuvant therapy for management of intraocular retinoblastoma

The aim of the current study is to investigate the effectiveness of combined chemoreduction and local ophthalmic therapy for treatment of intraocular retinoblastoma with the goal of avoiding enucleation and/or external beam radiotherapy [EBRT]. This is a prospective non - randomized study. Fifty-seven eyes were followed in 43 children with intraocular retinoblastoma who attended to the pediatric unit of Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine [NEMROCK] during the period from March 2002 till March 2004. Eiligible patients were treated with a six-cycle protocol of vincristine, etoposide, and carboplatin [VEC]. When maximum retinal tumors regression was achieved, adjuvant treatment [thermotherapy or cryotherapy] was delivered without randomization to the smallest possible tumor volume in an effort, if possible, to avoid enucleation and/or EBRT. The mean age of the patients at presentation was 27.69 months [range 1-96 months]. The Reese-Ellsworth classification included, group I non, group II in 6 eyes [10.5%], group III in 13 eyes [22.8%], group IV in 21 eyes [36.9%], and group IV in 17 eyes [29.8%]. In 35 eyes combined chemoreduction and local ophthalmic therapy were successful in terms of avoidance of enucleation and/or EBRT, with a success [globe salvage] rate of 61.4%. All Reese-Ellsworth group II and III eyes responded to the conservative approach, whereas only 12/21 [57.1%] and 4/17[23.5%] of group IV and V eyes respectively, responded. Seven eyes [12.3%] required EBRT, 5 eyes [8.8%] required enucleation and 10 eyes [17.5%] required a combination of EBRT and enucleation. Event-free survival [i.e, free of EBRT or enucleation] for the study population at one year was 50.8%. In retinoblastoma patients with Reese-Ellsworth eye groups 1, 2, or 3, systemic chemotherapy used with local ophthalmic therapies can eliminate the need for enucleation or EBRT without significant systemic toxicity. More effective therapy is required for Reese-Ellsworth eye groups 4 and 5

Brain metastases of pediatric solid tumors

The aim of the current study is to evaluate the incidence, pattern of metastases [whether isolated, multiple or associated with local recurrence of primary tumor or metastases to other sites], treatment outcome and prognosis of brain metastases in pediatric patients with extracranial solid tumors excluding lymphomas. Eighteen patients with extracranial pediatric solid tumors [excluding lymphomas] and brain metastases, were retrospectively studied during the period from September 1997 till January 2003. The relevant data of each patient were obtained from the medical records of The Pediatric Unit of Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine [NEMROCK]. At diagnosis all patients were assessed by careful history taking, complete physical examination, laboratory as well as radiological assessment. Follow-up was done by radiological imaging of the primary tumor as well as the metastatic sites [including the brain] immediately after finishing active treatment and then every 3 months for 1 year. Brain metastases occurred after initial treatment of the primary tumor with a median period of 6 months [range 1-11 months]. Eight patients had solitary metastases and in 10 patients metastases were multiple. The median time for disease progression was 19 months and median survival was 5.8 months [3 days - 12 months]. The median survival of solitary and multiple metastases was 5.5 and 4.1 months respectively, and the median survival of metachronous and synchronous brain metastases was 5 months and 2.9 months respectively. The possibility of development of brain metastases is highly increased with the presence of poor prognostic features. Patients presented with disseminated disease, especially in the presence of poor performance status are better to receive no active treatment, only supportive measures as the treatment outcome is very poor

Neuroblastoma: analysis of treatment outcome of various therapeutic approaches at NEMROCK

Purpose: The aim of the present study is to focus on treatment outcome of different therapeutic approaches in children with neuroblastoma treated at Kasr EL-Eini Center of Radiation Oncology and Nuclear Medicine [NEMROCK] and its relation to various prognostic factors

Patients and Methods: This retrospective study in: eluded all children with neuroblastoma who were treated at NEMROCK from January 1991 to December 2000. Analysis of various prognostic factors mainly, age at presentation, stage of the disease, biologic variables, different treatment modalities and their impact on response rate and survival

Results: Fifty-eight cases of neuroblastoma patients were recorded among 1601 total pediatric malignant cases with rulative frequency of 3.7% of all malignancy during the years 1991 to 2000 at NEMROCK. The male to female ratio was 0.84: 1. The Mean age was 31.59 +/- 20.77 months for males and 38 +/- 31.79% months for females. 79.6% of the cases were below 5 years. The peak age of presentation was 36 months for both sexes. Stage I disease was found in 13.56% of the cases while stage IV disease was found in 52.54% of the cases. 60% of cases [41/59] had a marker study [NSE], 85.37% [35/41] of them were highly positive. Combined treatment modalities had significantly superior results compared to chemotherapy alone or surgery alone as regards. The disease-free survival [DFS] [p=0.002]. Radiotherapy alone did not affect the overall survival [OAS] or response rate [p=0.15 and =0.85 respectively]. Similarly surgery alone did not affect OAS or response rate, [p= 0.23 and 1=0.31 respectively] but affected three-year survival [p=0.023]. The type of chemotherapy protocol [OPEC/OJEC versus other combination chemotherapy] did not affect the OAS [p =0.27] or response rate [p=0.22]. However, the toxicity was higher for combined chemotherapy protocols compared to OPEC/OJEC protocol, [p=0.04]. Metaiodobenzylguanidine [MIBG] therapy did affect the OAS [p=0.006] and 2- year survival [p=0.035] but did not affect the response rate [p=0.18]. The OAS was 54.24% at 6 months and 32.2% at 12 months. Meanwhile it reached 15.25% at 18 months and 6.78% at 3 years. The mean survival time was 11.2 months. Cases younger than 1 year of age at diagnosis had longer survival than others at 36 months

Conclusion: Despite increases in the intensity of treatment of nuroblastoma with chemoradiotherapy, MIBG, surgery and its advances, even bone marrow transplantation, the prognosis of neuroblastoma is still poor. Thus new approaches for screening, early diagnosis, new drugs and follow up are needed for better outcome